Paronychia, or Whitlow, named also, Panaris, Onychia, Onychia maligns, and Panaritium, is so common an infection attacking the finger, that all are familiar with it; writers, however, make out a number of species, as detailed in the Edinburgh Medical Journal, No. 95, which subdivision ap pears truly frivolous and unnecessary; in general, the less the finger is diseased, the more the hand, fore-arm, and arm are affected. It is usually a phlegmonous inflammation attacking the finger near the point, but sometimes is erysipelatons, and arises from a variety of causes, some of which are occasionally very obscure, or entirely unknown. The causes are commonly cold, a piece of the nail fretted, or what is vulgarly termed rag-nail, a prick or wound in the finger from a thorn, small splinter of wood, needle, hook, scalpel, forceps, spicula of bone, a broken bottle, an abrasion, or dirt getting access to the cutis beneath the nail. The finger affected generally presents a swollen inflamed appearance, and has a painful hot throb bing sensation. In some cases the malady is confined to the nail and its vicinity; in others the finger feels acutely painful, the pain extending to the hand and fore-arm, with little or no tu mefaction; in others again, the pain is confined solely to the finger, unaccompanied with tume faction. When confined to the nail and neglected, there commonly shoots forth a fungoid excres cence, and the finger becomes swollen and deformed. From what has been stated, a whitlow may be con sidered a disease of the finger, of an inflamma tory nature, attacking one or all the structures, rapidly terminating in suppuration, and occasion ally in gangrene even of the hones; and as the in flammation, suppuration, and gangrene arc liable to extend upwards along the arm, fatal conse quences may ensue.
As the finger is exceedingly sensitive and vas cular, whitlow should be treated early and vigor ously. If the finger be merely inflamed, and no degree of tension, warm poultices, with absolute rest and low diet, will be sufficient; but if there is tension, or matter apparent]) secreted, a longi tudinal incision of some depth should be freely made in the centre of the linger, and generally on the palmar aspect, to give relief, and to extract blood locally. When the cuticle acts as a sheath, and restrains the expansion of the inflamed finger, it ought to be cut off with scissors: and when matter insulates the nail, the latter should be re moved with scissors and forceps. otherwise a fun gous excrescence germinates around it, forming what is termed vim ?nail 1710th, or in common language, the growth of the nail into the flesh, when the slightest motion causes exquisite pain. The nail then is more diffi •ult to remove, produces more pain, and the excrescence requires to be re moved with the scalpel and escharotics, or both. The best escharotie is the nitrate of copper. This latter variety often attacks the toes, especially the great one, and various ways have been devised to remove this source of irritation, by Pare, Du puytren, and \Vardrop, the last of which is the preferable, and is detailed in No. 209 of the Lancet.
if the hand be involved in the disease, it should be treated as recommended fortrl .n..ammation of the vein, and if the inflammation still continue, one or two incisions should be made in the palm of the hand, to divide the palmar fascia so as to re move the tension and obviate permanent contraction of the hand, care being taken not to wound the palmar arch of the ulnar artery, an incision may be also necessary on the hack of the hand. the
disease extend to the fore-arm or arm, the same treatment will be required as in inflammation of the fascia. In this affection the phalanges of the fingers become soon carious, proving the necessity of active treatment; and whenever the bone or bones are ascertained to be bare or rough, they should be removed either by extracting them individually or by amputation; on some rare occasions, the finger degenerates into a carcinomatous condition, and re quires to be amputated.
The fascia palmaris, especially the threads ex tending along the fingers, is frequently so contracted from this malady as to impede the functions of the fingers or even the whole hand, and should there fore be divided by a cross incision, the fingers being afterwards held out straight by a piece of wood. From an attentive examination of such fingers in the dissecting room, we can speak with confidence of the nature of this contraction; the tendon being only gradually contracted, in conse quence of this arch of the fascia palmaris being so: and from the different positions in which the fingers are held, the same derangement takes place in their joints, which progressively become dislocated.
Pure and simple whitlow, the most common affection resulting from punctures in the dissecting room, is frequently produced from the puncture of a hook, scalpel, forceps, needles, or the spicula of a rib, in the examination of die thoracic viscera. In the mildest cases, there is merely a small serous vesicle of a milky colour, from being filled with a fluid more or less purulent, and surrounded with an erysipelatous or phlegmonous blush. In the severest cases, the disease is either at once ushered in with rigors, high constitutional excitement, ad vancing rapidly to typhus, with a peculiar des pondency of mind, or the inflammation extends along the fore-arm and arm to the axilla and thorax, involving the muscles of the axilla, those situated on the thorax, and even those on the abdomen and back, resembling erysipelas phlegmonodes, or in flammation of the fascia consequent on venesection at the bend of the arm: indeed the only difference between these affections is, that in this originating from a puncture in morbid dissection, we have frequently no chain of connection between the punc ture and the muscles and cellular tissue of the axilla; but the same want of connection, or cause and effect, appears to exist in erysipelas and a wounded nerve succeeding to phlebotomy. There can scarcely be a shadow of doubt, that in one and all of these affections, some exciting cause must have existed; and that although the wound healed in either without being observed, yet nevertheless it must have inflicted irritation or excitement, or a morbid action, either in a lymphatic, a nerve, or a blood-vessel, which has not been called into action until the constitution was excited either by stimula tion or by fever induced by cold. We have known many by dining out and indulging in wine, rouse to action such punctures even when healed; also if afterwards attacked with febrile symptoms induced by cold. The lymphatic vessels appear to be those which suffer, because the axilla is the most frequent seat of the first development of this affection, and yet the glands situated there are seldom affected. The greater number of individuals are affected in consequence of being punctured while labouring under some febrile attack. The mind has a power ful influence in this disease.